Through the years many doctors have pointed the importance of the iliopsoas in relation to low back pain and viscera of the human body.
One of the major contributors to back pain and hip pain is the Iliopsoas muscle tendonitis.
Comprise of two muscles, the iliacus and the psoas, joined laterally by the psoas tendon, the iliopsoas is the major hip flexor, and postural stabilizer of the body. The symptoms of an iliopsoas muscle spasm are diffuse lower back pain of a few days onset. The pain spreads to the rest of the low back, lower thoracic and sometimes even into the gluteal regions.
Psoas syndrome, Psoas Insufficiency Syndrome, or Psoas Hypertonicity
The Psoas Insufficiency Syndrome was introduced by Bachrach in 1987 and it is well accepted as a source of back pain.
Inadequacy of the lumbosacral compensatory mechanisms for contracture, shortening, or failure of adaptive lengthening of the psoas produces psoas syndrome.
Spasmed psoas will have a domino effect on the body.
The psoas increases lumbar lordosis and also the load on the facets contributing to:
- thoracolumbar paravertebral myophascial systems shortening,
- the pelvis drops in anterior rotation,
- and the abdominals are overstretched.
Sacroiliac joint also stiffens.
There is a compensatory increase in :
- the thoracic kyphosis,
- the head is forward,
- and the cervical spine tends to flatten.
In psoas dysfunction the lumbosacral hyper-lordosis can cause degenerative changes in the L5-S1 intervertebral disc and stretch the thoracolumbar long ligament as well. Traction of the sympathetic and somatic motor fibers to the psoas may ensue. Pain with coughing can also be provoked from sacroiliac joint dysfunction.
Common sites of psoas dysfunction referral are the anterior thighs and central low back pain.
My review in search of a dysfunction of the psoas looks roughly like this :
Spinal Mobility assessment unless restriction is present in more than 3 planes can not predict outcome for low back pain sufferers.
The “lateral lumbar shift” and “lateral side bend” tests for the lumbar spine are objective tools to diagnose lumbar dysfunction and guide treatment.
Sacroiliac joint mobility is not a reliable predictor of sacroiliac joint pathology, asymmetry is.
Pain provocation tests : distraction test, compression test, POSH test and sacral shear test.
Psoas muscle test
Modes of occurrence of psoas pain :
Patient with a psoas syndrome may present with pain at the thoracolumbar, lower lumbar or sacroiliac area, sometimes referring pain to the knee.
They state that the psoas pain is never midline and is often relieved by sitting. The anterior thigh pain associated with an acute scoliosis due to a disc herniation is often due to a compensating iliopsoas spasm splintering the spine away from the irritation.
With a unilateral psoas spasm, the patient might be flexed forward with the lumbar spine drawn downward, forward, and rotated to the opposite side. The hip might be externally rotated with the foot everted.
Why is the psoas strained ?
The psoas will stay contracted because of postural habits and trauma.
The way we stand, walk and sit can distort the psoas. If we walk or stand with our chin in an overly forward position the muscle will tighten. Sitting through much of the day causes the muscle to shorten to keep us bio-mechanically balanced in our chairs. Over time we develop a “normal” way of holding the psoas that is dysfunctional.
Unresolved trauma can keep the psoas short and reactive. This is a primary muscle in flight, fight, freeze or fear responses to danger. When survival is at stake, it propels the body to hit the ground running. When startled, it ignites preparation of the extensor muscles to reach out or run. Until the psoas is released the muscle may stay contracted and go into further shortening and spasm very easily.
Dananberg HF, Lower back pain as a gait-related repetitive motion injury. In Leeming A, Mooney V, Dorman T, Snider C, Stocker R: Movement, Stability and Low Back Pain. Churchill Livingstone, 1997, pp. 253-267
Dangaria TR, Naesh O, Changes in Cross-Sectional Area of Psoas Major Muscle in Unilateral Sciatica Caused by Disc Herniation. Spine 1998, 23(8): 928-931
Donelson R, Aprill C, Medcalf R, Grant W, A Prospective Study of Centralization of the Lumbar and Referred Pain. A predictor of symptomatic discs and annular competence. Spine, 1997, 22(10): 1115-1122
Bernard TN, The role of sacroiliac joints in low back pain: basic aspects of pathophysiology and management. In Leeming A, Mooney V, Dorman T, Snider C, Stocker R: Movement, Stability and Low Back Pain. Churchill Livingstone, 1997,pp. 73-88
Bullock-Saxton JE, Janda V, Bullock M Reflex Activation of Gluteal Muscles in Walking. An approach to restoration of muscle functions for patients with low back pain. Spine 1993, 18(6): 704-708
Black KM, McClure P, Polansky M, The Influence of Different Sitting Positions on Cervical and Lumbar Posture. Spine, 1996 21(1): 65-70
Bohannon R, Gajdosik R, LeVeau BF, Contribution of Pelvic and Lower Limb Motion to Increases in the Angle of Passive Straight Leg Raising. Physical Therapy 1985, 65(4): 474-477